AB0480 IS TRADITIONAL CHINESE MEDICINE A GOOD OPTION IN METHOTREXATE-BASED COMBINATION THERAPIES IN RHEUMATOID ARTHRITIS: A SYSTEMATIC REVIEW AND BAYESIAN NETWORK META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS
Authors: Z. Yang, Q. Liang, Y. Liang, M. Wang, R. Huang
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Former findings suggested that MTX-based combination therapies show improved efficacy and safety compared to monotherapy <sup>[1]</sup>. Several studies <sup>[2]</sup> have been conducted analysis on MTX-based combination therapies, but there is a lack of systematic analysis involving MTX+TCM (Traditional Chinese medicine) therapies. <h3>Objectives</h3> To assess the effectiveness and adverse events of Methotrexate-based (MTX-based) combination therapies(especially MTX + TCM therapies) in rheumatoid arthritis (RA) treatment. <h3>Methods</h3> A comprehensive search of PubMed, Embase, the Cochrane Library, China National Knowledge Infrastructure (CNKI), the Database for Chinese Technical Periodicals and Wanfang data was done without language restriction. A systematic review and network meta-analysis included randomized controlled trials of MTX-based combination therapies and methotrexate monotherapy. The ability of different regimens to reduce rheumatoid factors and inflammatory indicators and the probability of adverse reactions were compared. This study has been registered with PROSPERO under the number CRD42022265799. <h3>Results</h3> A total of 37 studies, including 3119 patients, were eligible for inclusion. Meta-analysis results showed that methotrexate combined with other DMARDs or Traditional Chinese Medicine (TCM) could reduce serum Rheumatoid Factor (RF) and C-reactive protein (CRP) levels to some extent, but the therapies combined with TCM were more effective and had a lower rate of adverse effects. The results of RF reducing ability were ranked in ascending order: MTX+LEF+TCM &gt; MTX+SSZ+HCQ &gt; MTX+LEF &gt;MTX+TCM &gt;MTX+HCQ &gt;MTX.While the results of CRP reducing ability were ranked in ascending order: MTX+LEF+TCM&gt;MTX+SSZ+HCQ&gt;MTX+LEF&gt;MTX+TCM&gt;MTX+HCQ. <h3>Conclusion</h3> Overall, MTX-based combination therapies are an effective treatment, and the combination of TCM and MTX-based combination therapies is more effective and safer. For treating rheumatoid arthritis or patients with an inadequate response to MTX, MTX-based combination therapies remain an alternative, cost-effective option. To support and validate the potential of TCM and MTX-based combination therapies in treating RA, large-scale, high-quality RCTs should be conducted in the future to provide more accurate and complete data. <h3>References</h3> [1]Bredemeier M, Ranza R, Kakehasi AM.et al.Safety of the Methotrexate-leflunomide Combination in Rheumatoid Arthritis: Results of a Multicentric, Registry-based, Cohort Study (BiobadaBrasil). J Rheumatol. 2022 Jan;49(1):122. [2]Hazlewood GS, Barnabe C, Tomlinson G.et al.Methotrexate monotherapy and methotrexate combination therapy with traditional and biologic disease modifying antirheumatic drugs for rheumatoid arthritis: abridged Cochrane systematic review and network meta-analysis. BMJ. 2016 Apr 21;353:i1777. <h3>Disclosure of Interests</h3> None declared. <h3>Disclosure of Interests</h3> None Declared.